8 ms·

Florida Eases Licensing Requirements for Foreign Trained Doctors

73 points by kamaraju 2y ago

OutOfHere 2y ago
In the US, medicine is a racket where the supply is intentionally constrained. Changes such as these should help ease the burden of doctor cost and availability.
- modeless 2y ago
  It's amazing how people just accept that it takes 6 months or more to see a specialist and don't realize that it is de facto rationing caused by intentional supply restriction.
  - klipt 2y ago
    People prefer to argue endlessly about private vs state funded healthcare without realizing that issue is completely orthogonal to the massive doctor shortage. Same thing with the housing debate really. People prefer to argue snot rent control instead of just building more housing.
    - Tade0 2y ago
      You can't outpace investment demand - especially not in the phase when housing is used as collateral to borrow in order to invest in more housing. China reportedly has currently enough housing stock to house their population twice over. Did that make housing cheap? Hardly. We're only seeing sustained price decreases now that the bubble is bursting, but it's not going to make real estate more affordable, as it comes with a heavy economic downturn.
      - seanmcdirmid 2y ago
        Houses built in the wrong place aren’t useful. Also, allowing hoarding of housing (viable since no property tax) can also restrict supply. There are plenty of reasons why more housing doesn’t necessarily lead to cheaper housing. Even inside 4th ring in East Beijing, we estimated that the block we were living in was only 60% or so occupied (by counting lights on nightly walks), much of the rest of the 40% were probably not even renovated.
        eru 2y ago
        > Also, allowing hoarding of housing (viable since no property tax) can also restrict supply. I don't see how property tax makes any difference here? The opportunity cost in terms of lost rent (if you are hoarding vacant property instead of renting it out) should be the same no matter what the property tax is? > There are plenty of reasons why more housing doesn’t necessarily lead to cheaper housing. If you can find a market that you can keep adding supply into, and prices don't react, you found yourself an infinite money machine! (It's the same mechanism as when people complained that printing money (whether by the Bank of Japan in the 1990s or the Fed in the 2010) can't raise inflation: Instead of complaining, you should keep printing money and gradually buy up the whole world in return for some ink and paper / database entries.)
        seanmcdirmid 2y ago
        That was China’s thinking, but it turns out there is a limit, it’s just not a gradual slope downward but a huge crash.
        eru 2y ago
        What makes you think so? The Chinese problems come from different sources. For example, there's lots of corruption, they are not keeping their nominal GDP on a stable growth target, and if I remember right, they have a lot of government intervention in the real estate and credit markets. See https://www.econlib.org/the-confusing-china-debate/ https://www.econlib.org/the-confusing-china-debate/ for an assessment more qualified than mine. And https://scottsumner.substack.com/p/chinas-mysterious-deflation https://scottsumner.substack.com/p/chinas-mysterious-deflati... for something more recent.
      - ChadNauseam 2y ago
        is this housing stock in places where people want to live? I find it hard to believe that half the units in hong kong or shanghai are vacant
      - kelnos 2y ago
        > China reportedly has currently enough housing stock to house their population twice over. Did that make housing cheap? Hardly. If you build housing where people don't care to live, it doesn't matter how much you build. Housing will be more expensive in desirable areas unless you build more housing in those desirable areas.
      - AnthonyMouse 2y ago
        > You can't outpace investment demand - especially not in the phase when housing is used as collateral to borrow in order to invest in more housing. Suppose housing prices are high. A construction company exists and has a million dollars, so they buy a $500,000 home, knock it down and spend $500,000 to build half a dozen condo units the size of the original house on the same lot, then sell them each for $500,000. That takes six months to a year. Now the construction company has three million dollars and buys three lots and makes nine million dollars, do you see where this is going? The thing that prevents this is when either a) they're not allowed to knock down the house and build condos there, or b) you pass laws that make it cost $3,000,000 to build a six-unit condo instead of $500,000, and then the unit is never going to cost less than $500,000 because it costs that much to build. > China reportedly has currently enough housing stock to house their population twice over. Did that make housing cheap? China is hardly an example of markets. But it's a good demonstration of why you need to allow housing to be built anywhere that it's needed instead of having bureaucrats decide where it should go. > We're only seeing sustained price decreases now that the bubble is bursting, but it's not going to make real estate more affordable, as it comes with a heavy economic downturn. We made a mistake with the last housing crisis, which was to reinflate the bubble with low interest rates. What you really want in that circumstance is to increase take home pay, e.g. by lowering taxes on the middle class.
        eru 2y ago
        The commenter you replied to makes the mistake of mistaking the price of houses as a capital good with the monthly rent you pay for housing services. If you want lots of new houses being built, high house prices are good. That incentivises developers to jump through all the hoops, build some houses, and sell them. (In the wake of the Great Recession, we had and have the opposite problem: tightening of credit dropped house prices, thus house construction was choked off, and thus rents rose. The ratio of rents to house prices went up, and rents also went up in absolute terms.)
        Tade0 2y ago
        > That incentivises developers to jump through all the hoops, build some houses, and sell them. That doesn't help with affordability, as when house prices are high they're... unaffordable anyway, so they get bought out by investors, who can produce any amount of cash as long as the investment pays off. For this reason a huge chunk of new housing is not even built to be affordable - both the margins and ROI on a "premium" apartment are just better. A win for investors and developers alike while at the same time regular people are thrown under the bus.
      - eru 2y ago
        > You can't outpace investment demand - especially not in the phase when housing is used as collateral to borrow in order to invest in more housing. Huh? What kind of weird statement is this? It seems there's a lot of confusion. I think it mostly stems from owner-occupiers. For our analysis, let's separate them into two: some people own houses and rent them out, and everyone (but the homeless) rent houses. It's just that sometimes people rent from themselves. What matters for discussions about affordability of housing is how much of your income you have to spend each month on housing every month. Let's call that 'housing services'. That is pretty much a function of available supply every month vs demand every month. Who owns them doesn't make a difference. If an investor buys a house, but rents it out, that's fine. Neither supply of housing services nor demand for housing services has changed. If an investor buys a house, but doesn't rent it out (eg because it's intentionally empty, or because the investor lives there herself), then she counts as a consumer of that unit for that month. That's an indirect change in supply and demand for housing services, but doesn't directly have anything to do with the investor as a owner. Now to come to your scenario: If investors use houses as collateral to invest in more housing, that's great! Ideally that will drive up the prices of housing as a capital god. The more expensive houses are as a capital good, the more it makes sense for developers to jump through all the hoops and build more houses to sell them into the market. That means more houses available for renting out, which drives down rents. (In the wake of the Great Recession, we had and have the opposite problem: tightening of credit dropped house prices, thus house construction was choked off, and thus rents rose. The ratio of rents to house prices went up, and rents also went up in absolute terms.)
      - IG_Semmelweiss 2y ago
        When your housing inventory is located on no mans land, and your economic policy is largely built on top of assumptions that housing should be an infinitely-appreciating asset (instead of a depreciating asset, like any other hars asset) , then you end up with china prices. And I'm not even mentioning the fact that the Chinese birthrate decline is so precipitous that their current population is expected to half by 2100. The chinese market of housing does not reflect real supply or prices. It instead reflects bad incentives and an economic bubble propped by the centralized state
    - sidewndr46 2y ago
      What is snot rent control?
      - klipt 2y ago
        Swipe typo! I meant "about"
  - tivert 2y ago
    Some level of supply restriction is probably warranted, though less than what we have now. It would be bad policy to have talented people train intensely for 8+ years, only to have them emerge on the other side with a "sorry, oversupply, no job for you." I think availability of lengthy and highly-specialized training programs needs to be carefully calibrated to avoid other kinds of rackets (like have been seen with law schools and certain kinds PhD programs).
    - throwup238 2y ago
      We do it all the time with lawyers and PhD scientists of all stripes. Why should doctors receive special treatment? (Wrote this before your edit introducing the second paragraph)
      - tivert 2y ago
        > We do it all the time with lawyers and PhD scientists of all stripes. Why should doctors receive special treatment? We shouldn't do that with lawyers and PhDs either. Why must everything be a race to the bottom?
        OutOfHere 2y ago
        The free market philosophy dictates that we absolutely should do it, and it's a good philosophy to follow.
        tivert 2y ago
        > The free market philosophy dictates that we absolutely should do it, and it's a good philosophy to follow. Sorry, it's never a good idea to base real life policy on ideological dogma. The "free market philosophy" has some good ideas, as well as a lot of bad ones. We shouldn't blindly follow its "dictates." In my experience, the people who dogmatically preach the free market frequently have an oversimplified understanding or use circular logic to conclude the free market is good by redefining good as whatever the free market does.
  - eru 2y ago
    The rationing is 'caused' by price caps (whether by law or informally observed). Supply restrictions just restrict available supply, they don't cause long waits by themselves. (Of course, this assumes that you don't want to re-interpret prices themselves as a form of rationing. That's a decent approach to take in some contexts, but eg doesn't gel with the common usage like 'food was rationed during the war', where we use 'rationing' in contrast to the usual price mechanism.)
    - cameldrv 2y ago
      There are no price caps. If you're rich, you have concierge medicine, and you'll see a great specialist whenever you want. The supply restrictions (and other things that reduce doctor productivity) cause a lack of supply relative to the amount of medical care that would be medically useful for the population. For people of normal income with normal medical insurance, that means that their care has to be rationed, or it would be unaffordable.
      - eru 2y ago
        If there's such a long queue, why don't doctors raise prices until the queue goes away? Do doctors not like money? > If you're rich, you have concierge medicine, and you'll see a great specialist whenever you want. You don't need to be that rich to go see a doctor privately in eg the UK. And, yes, they have crazy queues for the NHS, while the same doctor can be had for a bit of money quickly when seen privately. In that case, the price restriction comes from what the NHS is willing to pay. And because patient don't directly pay for the NHS, at least not proportional to the usage, instead of rationing via price the system rations via wait times. > [...] the amount of medical care that would be medically useful for the population. I'm not sure there's such a thing. There's no clearly defined amount that is 'medically useful'. There are just gradually diminishing returns to more medicine (in a statistical sense).
        Snow_Falls 2y ago
        > If there's such a long queue, why don't doctors raise prices until the queue goes away? Do doctors not like money? You do understand the 'queue' are sick people who need treatment? If the 'queue' goes away then they're just untreated and potentially die. Doctors like money but, at least where I come from, you don't go into medicine for cash. You do it for ideals or respect or to have a job that means something. > I'm not sure there's such a thing. There's no clearly defined amount that is 'medically useful'. There are just gradually diminishing returns to more medicine (in a statistical sense). there is actually such a thing as overtreatment. There's this really interesting statistical point where too much testing can actually cause harm, even if the test it self is harmless, because it discovers things that wouldn't have really been a problem ('incidentalomas'). And, unfortunately, there does come a point at times where a patient cannot be helped and it is better to just let them enjoy what time they have left rather than subject them to more treatment and recovery time and all that.
  - silisili 2y ago
    When I lived in Florida it was about like that. I couldn't accept that so just asked for the soonest appointment anywhere, and was assigned a new Haitian lady about an hour away who wasn't booked up yet. Given the circumstances I expected the worst, but I was so amazed with her. She was tall, pretty, and extremely well spoken. Not that this matters a ton, just recalling my first impression shattering expectations. And she's the first doctor I've met that realized that my main problem was more with health anxiety than health itself and just kinda bro'd it out with me for a half hour. All of that is to say, if this is what to expect from foreign doctors vs the purposely supply constrained 'elites' I'm accustomed to, consider me 100% on board.
- blindriver 2y ago
  It's even worse in Canada.
- Calavar 2y ago
  > In the US, medicine is a racket where the supply is intentionally constrained. The correct solution in that case would be to increase CMS funding for US residency and fellowship spots (which was frozen for ~25 years). You should see this for what it is, salary suppression by importing foreign labor, in a similar vein to what the tech industry did with abusing the H1B system until fairly recently. It's easy to lower costs by cutting corners on quality, but that is not a pro patient move.
  - tivert 2y ago
    > It's easy to lower costs by cutting corners on quality, but that is not a pro patient move. They're doing that, too. See the proliferation of physician assistants and nurse practitioners.
  - eru 2y ago
    Foreigners are also people.
    - Calavar 2y ago
      Of course. But the right to practice medicine is not considered a innate human right, it's a privilege that has to be earned by completing specific training and demonstrating specific competencies. Your profile mentions that you live in Singapore. You may not realize that Singapore is very picky about which foreign medical credentials it accepts [1]. This is a safeguard that they provide to you as a (potential) patient. [1] https://www.healthprofessionals.gov.sg/docs/librariesprovider2/becoming-a-registered-doctor/list-of-medical-qualifications-eligible-for-consideration-for-c-reg-(23-july-2024).pdf?sfvrsn=64c8bb88_1 https://www.healthprofessionals.gov.sg/docs/librariesprovide...
      - eru 2y ago
        > But the right to practice medicine is not considered a innate human right, [...] Sorry, no opinion on medicine implied. My comment was meant to highlight the casual xenophobia of this sentence: > You should see this for what it is, salary suppression by importing foreign labor, [...] At the risk of making a comment on medicine: > Your profile mentions that you live in Singapore. You may not realize that Singapore is very picky about which foreign medical credentials it accepts [1]. This is a safeguard that they provide to you as a (potential) patient. No, it's not a safeguard. Just like it ain't in the US. The only thing necessary for a safeguard would be something like a rule that you need to sign tedious paperwork of acknowledgement before you can be treated by someone without the proper credentials. Not a ban. If Singapore cared about proper safeguards, they probably wouldn't allow all kinds of 'alternative' medicine. See eg https://www.healthprofessionals.gov.sg/tcmpb/en/registration-requirements https://www.healthprofessionals.gov.sg/tcmpb/en/registration... for 'Traditional Chinese Medicine'. (See also https://en.wikipedia.org/wiki/Traditional_Chinese_medicine https://en.wikipedia.org/wiki/Traditional_Chinese_medicine for how TCM isn't even all that traditional, it's a fairly recent invention. Though that article is mostly focussed on the PRC. It would be interesting to see how that contrasts with practices in Taiwan, Hong Kong and Singapore: places where Chinese culture escaped the Cultural Revolution.) (Of course, government policy, even of a generally competent place like Singapore, isn't really a coherent thing. So some people in the Gahmen and in interest groups care about safeguards, some care about protecting the 'guild', some care about other things like cultural heritage, etc and in the end you get some messy compromise.)
- jakub_g 2y ago
  It's the same in Europe as well. It's maddening. Every year I read of massively missing doctors, and at the same time, universities reject 90% of applicants or so because they don't have more places. So those doctors get "imported" from poorer countries, leading to brain drain and making situation in _those_ countries even worse. It's especially bad now that the societies are getting older and boomer generation retiring. I routinely read news like "the doctor in town X is 70 y.o. and wanted to retire but his patients couldn't find a new doctor, so he came back from retirement". In France every doctor wants to live and practice in big cities, there's even a term "medical deserts". In Poland on the other hand, it's very common that a doctor either works in multiple hospitals at the same time (and sometimes also has a private practice); or having cabinets in different towns and every day being in a different town. So in those small towns you can see a specialist like "once month on Wednesdays".
  - sunshine-o 2y ago
    True, and from what I have heard there is really a "lower cast" of staff being taken advantage of because they were trained abroad but working in EU hospitals. So as usual it is very hypocritical. In that sense Florida's move make sense. As always, it is that way of thinking that has been dominant in the west for at least 50 years: why bother making anything here if we can just import it for cheap?
  - Tade0 2y ago
    My neighbour is working towards qualifying to specialise in urology. Problem is, there are just 43 openings a year for the entirety of Poland. That puts a hard limit of less than 2k specialists total at any given moment unless we expect people to work in retirement. Currently there are around 1300 such people. How are they supposed to provide services for a country of 40mln residents?
- ww520 2y ago
  Yes, the boards of different states have quotas to limit the number of people passing the medical board exam each year. BTW, more doctors should follow what this doctor does. https://www.youtube.com/watch?v=yCtAdgpW_Vs https://www.youtube.com/watch?v=yCtAdgpW_Vs. Their website shows they're charging $40 per visit currently, vs $35 4 years ago.
- kurthr 2y ago
  I'd take this generally more seriously, if the number of licensed physicians in the US wasn't growing 3x faster than the population, or if the number of international medical graduates wasn't already 23%. The US population grew by 8% from 2010 to 2022, increasing from 309,327,143 to 333,287,557. The number of licensed physicians grew 23% from 850,085 to 1,044,734. So it's not retirements, or graduations and general licensure. It's the number of General Practitioners, and the number people they treat and amount of time they spend (not necessarily the care the patients receive) that makes wait times longer. The fact that almost all of them are now in larger (private equity controlled?) groups rather than working as independents. That many more choose to specialize for higher pay so that they don't have to work with the masses. It is in the interests of the insurance groups for the price of healthcare to rise since they make a percentage of that cost as profit. As long as everyone has to pay more the insurance companies can pay their executives more money and provide dividends to stockholders. They want all patient care to be a hassle. They want to mandate additional busy work to every transaction. They want drug prices to rise. It improves the bottom line. I don't know that brining in a few more doctors from Barbados or Australia or the UK is going to improve that, and it's probably going to make it worse in other places (that don't have for profit healthcare insurance). https://meridian.allenpress.com/jmr/article/109/2/13/494447/FSMB-Census-of-Licensed-Physicians-in-the-United https://meridian.allenpress.com/jmr/article/109/2/13/494447/...
- masklinn 2y ago
  The US is far from alone in that. numerus clausus is very common in med-related fields (medicine, pharmacy, dentistry, and vet). Now some limitation does make sense as there’s only so much space for rotations and internships, but the limits tend to be artificially low.
  - Neonlicht 2y ago
    Med school is government funded in my country- none of that bizarre student debt thing that America has. Ofcourse this does mean that there is a maximum budget for new students every year which works a cap.
- IG_Semmelweiss 2y ago
  Can you imagine a Federal law that makes state Medicare or Medicaid funding contingent on the state jurisdiction recognizing all professional licenses granted by all other US-states ? So that a practicing doctor etc could easily move their practice and their skills from say NJ to FL, without the hassle of maintaining multiple state licenses ? That would make an incredible revolution, and its not even touching the actual constraints inherent with the MD education barrier! Another one - bring back apprenticeship!
floydnoel 2y ago
> Specifically, Alabama, Colorado, Idaho, and Washington already have enacted such legislation. Many other states are considering similar bills. Fantastic. Licensing requirements are often insane and provide no value to consumers.
- triyambakam 2y ago
  Hawaii is the worst (in many regards, actually). There are "certificate-of-need laws" > CON laws require businesses that want to build a new medical facility or offer a new service to go through an arduous state approval process. Moreover, they must prove their service is “needed.” [1] [1] https://www.grassrootinstitute.org/2023/10/hawaii-healthcare-feeling-the-wrath-of-con-laws/ https://www.grassrootinstitute.org/2023/10/hawaii-healthcare...
  - eru 2y ago
    Aren't those common in most states in the US for new hospitals?
  - _aavaa_ 2y ago
    Naming them CON laws is a little on the nose isn't it?
garrettgarcia 2y ago
Does anyone know which and how many foreign medical schools qualify?
- tivert 2y ago
  > Does anyone know which and how many foreign medical schools qualify? This is about residency programs, not medical schools. IIRC, graduates of pretty much any foreign MD program can already practice in the US, they just need to complete a US residency.
- ghufran_syed 2y ago
  check the ecfmg website
DrammBA 2y ago
Does anyone know how would this interact with the USMLE, does it override it? Not sure why the downvotes for an honest question, could you at least point out what's wrong?
- aspenmayer 2y ago
  In case anyone else was, like me, unfamiliar with the abbreviation USMLE: https://en.wikipedia.org/wiki/United_States_Medical_Licensing_Examination https://en.wikipedia.org/wiki/United_States_Medical_Licensin...
  - mcsniff 2y ago
    If you're gonna do this, at least put it up front so people don't have to click a link. USMLE = United States Medical Licensing Examination.
    - aspenmayer 2y ago
      The one time I didn't quote. Thanks for the reminder to post better. I'm doing my best lol In all seriousness though, I did second-guess myself. I knew better.
- ghufran_syed 2y ago
  no, you still need usmle to get ecfmg certification. the difference is that you wont need US residency to get a state medical license
  - p0w3n3d 2y ago
    doesn't USMLE require you basically to finish studying in US?
    - maz1b 2y ago
      No, as long as you've graduated from medical school in a country that has accredited/globally recognized medical schools, you can take the steps (USMLEs), and thus you can get ECFMG certified.
johnnymonster 2y ago
Why don’t they ease up or streamline their zoning and permit process so people can build back their homes after hurricane damage?
- Larrikin 2y ago
  Will that be combined with less tax payer funding to those who build back their homes in places constantly hit by hurricanes?
nine_zeros 2y ago
It would really help for primary care doctors to start more private businesses - much like dentists. There is no reason to be stuck in hospital systems that grind doctors so much. The revenue savings from the hospital not taking cut might even make primary care a highly paid profession - enough to incentivize more people to take up this specialization.
- Calavar 2y ago
  > It would really help for primary care doctors to start more private businesses - much like dentists. You're talking about reversing tidal currents that have been in effect for over 30 years. It isn't happening. The financials make it increasingly difficult for lone hospitals to stay independent of big health systems, let alone small group practices and partnerships. Medicine has been corporatized and commoditized. Next comes enshitification. For example, dropping the requirement for American doctors to complete their training in America.
- rediguanayum 2y ago
  Hospitals don't provide primary care, and they are not the problem. The high cost of hospitals is due to insurance system incentivized for profits over efficiency and service to the patient: https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills https://www.propublica.org/article/why-your-health-insurer-d... It does not help that private equity has also discovered hospitals as a source of revenue: https://www.propublica.org/article/investors-extracted-400-million-from-a-hospital-chain-that-sometimes-couldnt-pay-for-medical-supplies-or-gas-for-ambulances https://www.propublica.org/article/investors-extracted-400-m.... To understand the true cost of the American medical system, I think you need to look over the border at most any other 1st world country's medical system. Doctor's training is lot cheaper, so more people are incentivized to go into primary care. Insurance is better regulated or single payer. Hospitals are not forced to provide free care (US EMTALA) that causes financial uncertainty. Patients are typically incentivized to not abuse the system unlike the US (e.g. Dilaudid drug abuse enabled by EMTALA)... etc etc...
  - 2Gkashmiri 2y ago
sawTinMoe 2y ago
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sawTinMoe 2y ago
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sawTinMoe 2y ago
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2Gkashmiri 2y ago
would this help doctors get a visa now that there is a "need" for them because local doctors are incapable of doing the work themselves?
dinobones 2y ago
Does this mean Caribbean medical school is less of a scam now?
tubalcain 2y ago
Credentials and skill levels differ widely worldwide. Many developing countries lack the infrastructure to train doctors for modern medicine, and the degree of corruption in those countries increases the risk of unqualified or questionable practitioners. This is not the right way to improve access.

73 points by kamaraju 2y ago

In the US, medicine is a racket where the supply is intentionally constrained. Changes such as these should help ease the burden of doctor cost and availability.

modeless 2y ago
It's amazing how people just accept that it takes 6 months or more to see a specialist and don't realize that it is de facto rationing caused by intentional supply restriction.
- klipt 2y ago
  People prefer to argue endlessly about private vs state funded healthcare without realizing that issue is completely orthogonal to the massive doctor shortage. Same thing with the housing debate really. People prefer to argue snot rent control instead of just building more housing.
  - Tade0 2y ago
    You can't outpace investment demand - especially not in the phase when housing is used as collateral to borrow in order to invest in more housing. China reportedly has currently enough housing stock to house their population twice over. Did that make housing cheap? Hardly. We're only seeing sustained price decreases now that the bubble is bursting, but it's not going to make real estate more affordable, as it comes with a heavy economic downturn.
    - seanmcdirmid 2y ago
      Houses built in the wrong place aren’t useful. Also, allowing hoarding of housing (viable since no property tax) can also restrict supply. There are plenty of reasons why more housing doesn’t necessarily lead to cheaper housing. Even inside 4th ring in East Beijing, we estimated that the block we were living in was only 60% or so occupied (by counting lights on nightly walks), much of the rest of the 40% were probably not even renovated.
      - eru 2y ago
        > Also, allowing hoarding of housing (viable since no property tax) can also restrict supply. I don't see how property tax makes any difference here? The opportunity cost in terms of lost rent (if you are hoarding vacant property instead of renting it out) should be the same no matter what the property tax is? > There are plenty of reasons why more housing doesn’t necessarily lead to cheaper housing. If you can find a market that you can keep adding supply into, and prices don't react, you found yourself an infinite money machine! (It's the same mechanism as when people complained that printing money (whether by the Bank of Japan in the 1990s or the Fed in the 2010) can't raise inflation: Instead of complaining, you should keep printing money and gradually buy up the whole world in return for some ink and paper / database entries.)
        seanmcdirmid 2y ago
        That was China’s thinking, but it turns out there is a limit, it’s just not a gradual slope downward but a huge crash.
        eru 2y ago
        What makes you think so? The Chinese problems come from different sources. For example, there's lots of corruption, they are not keeping their nominal GDP on a stable growth target, and if I remember right, they have a lot of government intervention in the real estate and credit markets. See https://www.econlib.org/the-confusing-china-debate/ https://www.econlib.org/the-confusing-china-debate/ for an assessment more qualified than mine. And https://scottsumner.substack.com/p/chinas-mysterious-deflation https://scottsumner.substack.com/p/chinas-mysterious-deflati... for something more recent.
    - ChadNauseam 2y ago
      is this housing stock in places where people want to live? I find it hard to believe that half the units in hong kong or shanghai are vacant
    - kelnos 2y ago
      > China reportedly has currently enough housing stock to house their population twice over. Did that make housing cheap? Hardly. If you build housing where people don't care to live, it doesn't matter how much you build. Housing will be more expensive in desirable areas unless you build more housing in those desirable areas.
    - AnthonyMouse 2y ago
      > You can't outpace investment demand - especially not in the phase when housing is used as collateral to borrow in order to invest in more housing. Suppose housing prices are high. A construction company exists and has a million dollars, so they buy a $500,000 home, knock it down and spend $500,000 to build half a dozen condo units the size of the original house on the same lot, then sell them each for $500,000. That takes six months to a year. Now the construction company has three million dollars and buys three lots and makes nine million dollars, do you see where this is going? The thing that prevents this is when either a) they're not allowed to knock down the house and build condos there, or b) you pass laws that make it cost $3,000,000 to build a six-unit condo instead of $500,000, and then the unit is never going to cost less than $500,000 because it costs that much to build. > China reportedly has currently enough housing stock to house their population twice over. Did that make housing cheap? China is hardly an example of markets. But it's a good demonstration of why you need to allow housing to be built anywhere that it's needed instead of having bureaucrats decide where it should go. > We're only seeing sustained price decreases now that the bubble is bursting, but it's not going to make real estate more affordable, as it comes with a heavy economic downturn. We made a mistake with the last housing crisis, which was to reinflate the bubble with low interest rates. What you really want in that circumstance is to increase take home pay, e.g. by lowering taxes on the middle class.
      - eru 2y ago
        The commenter you replied to makes the mistake of mistaking the price of houses as a capital good with the monthly rent you pay for housing services. If you want lots of new houses being built, high house prices are good. That incentivises developers to jump through all the hoops, build some houses, and sell them. (In the wake of the Great Recession, we had and have the opposite problem: tightening of credit dropped house prices, thus house construction was choked off, and thus rents rose. The ratio of rents to house prices went up, and rents also went up in absolute terms.)
        Tade0 2y ago
        > That incentivises developers to jump through all the hoops, build some houses, and sell them. That doesn't help with affordability, as when house prices are high they're... unaffordable anyway, so they get bought out by investors, who can produce any amount of cash as long as the investment pays off. For this reason a huge chunk of new housing is not even built to be affordable - both the margins and ROI on a "premium" apartment are just better. A win for investors and developers alike while at the same time regular people are thrown under the bus.
    - eru 2y ago
      > You can't outpace investment demand - especially not in the phase when housing is used as collateral to borrow in order to invest in more housing. Huh? What kind of weird statement is this? It seems there's a lot of confusion. I think it mostly stems from owner-occupiers. For our analysis, let's separate them into two: some people own houses and rent them out, and everyone (but the homeless) rent houses. It's just that sometimes people rent from themselves. What matters for discussions about affordability of housing is how much of your income you have to spend each month on housing every month. Let's call that 'housing services'. That is pretty much a function of available supply every month vs demand every month. Who owns them doesn't make a difference. If an investor buys a house, but rents it out, that's fine. Neither supply of housing services nor demand for housing services has changed. If an investor buys a house, but doesn't rent it out (eg because it's intentionally empty, or because the investor lives there herself), then she counts as a consumer of that unit for that month. That's an indirect change in supply and demand for housing services, but doesn't directly have anything to do with the investor as a owner. Now to come to your scenario: If investors use houses as collateral to invest in more housing, that's great! Ideally that will drive up the prices of housing as a capital god. The more expensive houses are as a capital good, the more it makes sense for developers to jump through all the hoops and build more houses to sell them into the market. That means more houses available for renting out, which drives down rents. (In the wake of the Great Recession, we had and have the opposite problem: tightening of credit dropped house prices, thus house construction was choked off, and thus rents rose. The ratio of rents to house prices went up, and rents also went up in absolute terms.)
    - IG_Semmelweiss 2y ago
      When your housing inventory is located on no mans land, and your economic policy is largely built on top of assumptions that housing should be an infinitely-appreciating asset (instead of a depreciating asset, like any other hars asset) , then you end up with china prices. And I'm not even mentioning the fact that the Chinese birthrate decline is so precipitous that their current population is expected to half by 2100. The chinese market of housing does not reflect real supply or prices. It instead reflects bad incentives and an economic bubble propped by the centralized state
  - sidewndr46 2y ago
    What is snot rent control?
    - klipt 2y ago
      Swipe typo! I meant "about"
- tivert 2y ago
  Some level of supply restriction is probably warranted, though less than what we have now. It would be bad policy to have talented people train intensely for 8+ years, only to have them emerge on the other side with a "sorry, oversupply, no job for you." I think availability of lengthy and highly-specialized training programs needs to be carefully calibrated to avoid other kinds of rackets (like have been seen with law schools and certain kinds PhD programs).
  - throwup238 2y ago
    We do it all the time with lawyers and PhD scientists of all stripes. Why should doctors receive special treatment? (Wrote this before your edit introducing the second paragraph)
    - tivert 2y ago
      > We do it all the time with lawyers and PhD scientists of all stripes. Why should doctors receive special treatment? We shouldn't do that with lawyers and PhDs either. Why must everything be a race to the bottom?
      - OutOfHere 2y ago
        The free market philosophy dictates that we absolutely should do it, and it's a good philosophy to follow.
        tivert 2y ago
        > The free market philosophy dictates that we absolutely should do it, and it's a good philosophy to follow. Sorry, it's never a good idea to base real life policy on ideological dogma. The "free market philosophy" has some good ideas, as well as a lot of bad ones. We shouldn't blindly follow its "dictates." In my experience, the people who dogmatically preach the free market frequently have an oversimplified understanding or use circular logic to conclude the free market is good by redefining good as whatever the free market does.
- eru 2y ago
  The rationing is 'caused' by price caps (whether by law or informally observed). Supply restrictions just restrict available supply, they don't cause long waits by themselves. (Of course, this assumes that you don't want to re-interpret prices themselves as a form of rationing. That's a decent approach to take in some contexts, but eg doesn't gel with the common usage like 'food was rationed during the war', where we use 'rationing' in contrast to the usual price mechanism.)
  - cameldrv 2y ago
    There are no price caps. If you're rich, you have concierge medicine, and you'll see a great specialist whenever you want. The supply restrictions (and other things that reduce doctor productivity) cause a lack of supply relative to the amount of medical care that would be medically useful for the population. For people of normal income with normal medical insurance, that means that their care has to be rationed, or it would be unaffordable.
    - eru 2y ago
      If there's such a long queue, why don't doctors raise prices until the queue goes away? Do doctors not like money? > If you're rich, you have concierge medicine, and you'll see a great specialist whenever you want. You don't need to be that rich to go see a doctor privately in eg the UK. And, yes, they have crazy queues for the NHS, while the same doctor can be had for a bit of money quickly when seen privately. In that case, the price restriction comes from what the NHS is willing to pay. And because patient don't directly pay for the NHS, at least not proportional to the usage, instead of rationing via price the system rations via wait times. > [...] the amount of medical care that would be medically useful for the population. I'm not sure there's such a thing. There's no clearly defined amount that is 'medically useful'. There are just gradually diminishing returns to more medicine (in a statistical sense).
      - Snow_Falls 2y ago
        > If there's such a long queue, why don't doctors raise prices until the queue goes away? Do doctors not like money? You do understand the 'queue' are sick people who need treatment? If the 'queue' goes away then they're just untreated and potentially die. Doctors like money but, at least where I come from, you don't go into medicine for cash. You do it for ideals or respect or to have a job that means something. > I'm not sure there's such a thing. There's no clearly defined amount that is 'medically useful'. There are just gradually diminishing returns to more medicine (in a statistical sense). there is actually such a thing as overtreatment. There's this really interesting statistical point where too much testing can actually cause harm, even if the test it self is harmless, because it discovers things that wouldn't have really been a problem ('incidentalomas'). And, unfortunately, there does come a point at times where a patient cannot be helped and it is better to just let them enjoy what time they have left rather than subject them to more treatment and recovery time and all that.
- silisili 2y ago
  When I lived in Florida it was about like that. I couldn't accept that so just asked for the soonest appointment anywhere, and was assigned a new Haitian lady about an hour away who wasn't booked up yet. Given the circumstances I expected the worst, but I was so amazed with her. She was tall, pretty, and extremely well spoken. Not that this matters a ton, just recalling my first impression shattering expectations. And she's the first doctor I've met that realized that my main problem was more with health anxiety than health itself and just kinda bro'd it out with me for a half hour. All of that is to say, if this is what to expect from foreign doctors vs the purposely supply constrained 'elites' I'm accustomed to, consider me 100% on board.
blindriver 2y ago
It's even worse in Canada.
Calavar 2y ago
> In the US, medicine is a racket where the supply is intentionally constrained. The correct solution in that case would be to increase CMS funding for US residency and fellowship spots (which was frozen for ~25 years). You should see this for what it is, salary suppression by importing foreign labor, in a similar vein to what the tech industry did with abusing the H1B system until fairly recently. It's easy to lower costs by cutting corners on quality, but that is not a pro patient move.
- tivert 2y ago
  > It's easy to lower costs by cutting corners on quality, but that is not a pro patient move. They're doing that, too. See the proliferation of physician assistants and nurse practitioners.
- eru 2y ago
  Foreigners are also people.
  - Calavar 2y ago
    Of course. But the right to practice medicine is not considered a innate human right, it's a privilege that has to be earned by completing specific training and demonstrating specific competencies. Your profile mentions that you live in Singapore. You may not realize that Singapore is very picky about which foreign medical credentials it accepts [1]. This is a safeguard that they provide to you as a (potential) patient. [1] https://www.healthprofessionals.gov.sg/docs/librariesprovider2/becoming-a-registered-doctor/list-of-medical-qualifications-eligible-for-consideration-for-c-reg-(23-july-2024).pdf?sfvrsn=64c8bb88_1 https://www.healthprofessionals.gov.sg/docs/librariesprovide...
    - eru 2y ago
      > But the right to practice medicine is not considered a innate human right, [...] Sorry, no opinion on medicine implied. My comment was meant to highlight the casual xenophobia of this sentence: > You should see this for what it is, salary suppression by importing foreign labor, [...] At the risk of making a comment on medicine: > Your profile mentions that you live in Singapore. You may not realize that Singapore is very picky about which foreign medical credentials it accepts [1]. This is a safeguard that they provide to you as a (potential) patient. No, it's not a safeguard. Just like it ain't in the US. The only thing necessary for a safeguard would be something like a rule that you need to sign tedious paperwork of acknowledgement before you can be treated by someone without the proper credentials. Not a ban. If Singapore cared about proper safeguards, they probably wouldn't allow all kinds of 'alternative' medicine. See eg https://www.healthprofessionals.gov.sg/tcmpb/en/registration-requirements https://www.healthprofessionals.gov.sg/tcmpb/en/registration... for 'Traditional Chinese Medicine'. (See also https://en.wikipedia.org/wiki/Traditional_Chinese_medicine https://en.wikipedia.org/wiki/Traditional_Chinese_medicine for how TCM isn't even all that traditional, it's a fairly recent invention. Though that article is mostly focussed on the PRC. It would be interesting to see how that contrasts with practices in Taiwan, Hong Kong and Singapore: places where Chinese culture escaped the Cultural Revolution.) (Of course, government policy, even of a generally competent place like Singapore, isn't really a coherent thing. So some people in the Gahmen and in interest groups care about safeguards, some care about protecting the 'guild', some care about other things like cultural heritage, etc and in the end you get some messy compromise.)
jakub_g 2y ago
It's the same in Europe as well. It's maddening. Every year I read of massively missing doctors, and at the same time, universities reject 90% of applicants or so because they don't have more places. So those doctors get "imported" from poorer countries, leading to brain drain and making situation in _those_ countries even worse. It's especially bad now that the societies are getting older and boomer generation retiring. I routinely read news like "the doctor in town X is 70 y.o. and wanted to retire but his patients couldn't find a new doctor, so he came back from retirement". In France every doctor wants to live and practice in big cities, there's even a term "medical deserts". In Poland on the other hand, it's very common that a doctor either works in multiple hospitals at the same time (and sometimes also has a private practice); or having cabinets in different towns and every day being in a different town. So in those small towns you can see a specialist like "once month on Wednesdays".
- sunshine-o 2y ago
  True, and from what I have heard there is really a "lower cast" of staff being taken advantage of because they were trained abroad but working in EU hospitals. So as usual it is very hypocritical. In that sense Florida's move make sense. As always, it is that way of thinking that has been dominant in the west for at least 50 years: why bother making anything here if we can just import it for cheap?
- Tade0 2y ago
  My neighbour is working towards qualifying to specialise in urology. Problem is, there are just 43 openings a year for the entirety of Poland. That puts a hard limit of less than 2k specialists total at any given moment unless we expect people to work in retirement. Currently there are around 1300 such people. How are they supposed to provide services for a country of 40mln residents?
ww520 2y ago
Yes, the boards of different states have quotas to limit the number of people passing the medical board exam each year. BTW, more doctors should follow what this doctor does. https://www.youtube.com/watch?v=yCtAdgpW_Vs https://www.youtube.com/watch?v=yCtAdgpW_Vs. Their website shows they're charging $40 per visit currently, vs $35 4 years ago.
kurthr 2y ago
I'd take this generally more seriously, if the number of licensed physicians in the US wasn't growing 3x faster than the population, or if the number of international medical graduates wasn't already 23%. The US population grew by 8% from 2010 to 2022, increasing from 309,327,143 to 333,287,557. The number of licensed physicians grew 23% from 850,085 to 1,044,734. So it's not retirements, or graduations and general licensure. It's the number of General Practitioners, and the number people they treat and amount of time they spend (not necessarily the care the patients receive) that makes wait times longer. The fact that almost all of them are now in larger (private equity controlled?) groups rather than working as independents. That many more choose to specialize for higher pay so that they don't have to work with the masses. It is in the interests of the insurance groups for the price of healthcare to rise since they make a percentage of that cost as profit. As long as everyone has to pay more the insurance companies can pay their executives more money and provide dividends to stockholders. They want all patient care to be a hassle. They want to mandate additional busy work to every transaction. They want drug prices to rise. It improves the bottom line. I don't know that brining in a few more doctors from Barbados or Australia or the UK is going to improve that, and it's probably going to make it worse in other places (that don't have for profit healthcare insurance). https://meridian.allenpress.com/jmr/article/109/2/13/494447/FSMB-Census-of-Licensed-Physicians-in-the-United https://meridian.allenpress.com/jmr/article/109/2/13/494447/...
masklinn 2y ago
The US is far from alone in that. numerus clausus is very common in med-related fields (medicine, pharmacy, dentistry, and vet). Now some limitation does make sense as there’s only so much space for rotations and internships, but the limits tend to be artificially low.
- Neonlicht 2y ago
  Med school is government funded in my country- none of that bizarre student debt thing that America has. Ofcourse this does mean that there is a maximum budget for new students every year which works a cap.
IG_Semmelweiss 2y ago
Can you imagine a Federal law that makes state Medicare or Medicaid funding contingent on the state jurisdiction recognizing all professional licenses granted by all other US-states ? So that a practicing doctor etc could easily move their practice and their skills from say NJ to FL, without the hassle of maintaining multiple state licenses ? That would make an incredible revolution, and its not even touching the actual constraints inherent with the MD education barrier! Another one - bring back apprenticeship!

floydnoel 2y ago

> Specifically, Alabama, Colorado, Idaho, and Washington already have enacted such legislation. Many other states are considering similar bills. Fantastic. Licensing requirements are often insane and provide no value to consumers.

triyambakam 2y ago
Hawaii is the worst (in many regards, actually). There are "certificate-of-need laws" > CON laws require businesses that want to build a new medical facility or offer a new service to go through an arduous state approval process. Moreover, they must prove their service is “needed.” [1] [1] https://www.grassrootinstitute.org/2023/10/hawaii-healthcare-feeling-the-wrath-of-con-laws/ https://www.grassrootinstitute.org/2023/10/hawaii-healthcare...
- eru 2y ago
  Aren't those common in most states in the US for new hospitals?
- _aavaa_ 2y ago
  Naming them CON laws is a little on the nose isn't it?

garrettgarcia 2y ago

Does anyone know which and how many foreign medical schools qualify?

tivert 2y ago
> Does anyone know which and how many foreign medical schools qualify? This is about residency programs, not medical schools. IIRC, graduates of pretty much any foreign MD program can already practice in the US, they just need to complete a US residency.
ghufran_syed 2y ago
check the ecfmg website

DrammBA 2y ago

Does anyone know how would this interact with the USMLE, does it override it? Not sure why the downvotes for an honest question, could you at least point out what's wrong?

aspenmayer 2y ago
In case anyone else was, like me, unfamiliar with the abbreviation USMLE: https://en.wikipedia.org/wiki/United_States_Medical_Licensing_Examination https://en.wikipedia.org/wiki/United_States_Medical_Licensin...
- mcsniff 2y ago
  If you're gonna do this, at least put it up front so people don't have to click a link. USMLE = United States Medical Licensing Examination.
  - aspenmayer 2y ago
    The one time I didn't quote. Thanks for the reminder to post better. I'm doing my best lol In all seriousness though, I did second-guess myself. I knew better.
ghufran_syed 2y ago
no, you still need usmle to get ecfmg certification. the difference is that you wont need US residency to get a state medical license
- p0w3n3d 2y ago
  doesn't USMLE require you basically to finish studying in US?
  - maz1b 2y ago
    No, as long as you've graduated from medical school in a country that has accredited/globally recognized medical schools, you can take the steps (USMLEs), and thus you can get ECFMG certified.

johnnymonster 2y ago

Why don’t they ease up or streamline their zoning and permit process so people can build back their homes after hurricane damage?

Larrikin 2y ago
Will that be combined with less tax payer funding to those who build back their homes in places constantly hit by hurricanes?

nine_zeros 2y ago

It would really help for primary care doctors to start more private businesses - much like dentists. There is no reason to be stuck in hospital systems that grind doctors so much. The revenue savings from the hospital not taking cut might even make primary care a highly paid profession - enough to incentivize more people to take up this specialization.

Calavar 2y ago
> It would really help for primary care doctors to start more private businesses - much like dentists. You're talking about reversing tidal currents that have been in effect for over 30 years. It isn't happening. The financials make it increasingly difficult for lone hospitals to stay independent of big health systems, let alone small group practices and partnerships. Medicine has been corporatized and commoditized. Next comes enshitification. For example, dropping the requirement for American doctors to complete their training in America.
rediguanayum 2y ago
Hospitals don't provide primary care, and they are not the problem. The high cost of hospitals is due to insurance system incentivized for profits over efficiency and service to the patient: https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills https://www.propublica.org/article/why-your-health-insurer-d... It does not help that private equity has also discovered hospitals as a source of revenue: https://www.propublica.org/article/investors-extracted-400-million-from-a-hospital-chain-that-sometimes-couldnt-pay-for-medical-supplies-or-gas-for-ambulances https://www.propublica.org/article/investors-extracted-400-m.... To understand the true cost of the American medical system, I think you need to look over the border at most any other 1st world country's medical system. Doctor's training is lot cheaper, so more people are incentivized to go into primary care. Insurance is better regulated or single payer. Hospitals are not forced to provide free care (US EMTALA) that causes financial uncertainty. Patients are typically incentivized to not abuse the system unlike the US (e.g. Dilaudid drug abuse enabled by EMTALA)... etc etc...
- 2Gkashmiri 2y ago

sawTinMoe 2y ago

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sawTinMoe 2y ago

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sawTinMoe 2y ago

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2Gkashmiri 2y ago

would this help doctors get a visa now that there is a "need" for them because local doctors are incapable of doing the work themselves?

dinobones 2y ago

Does this mean Caribbean medical school is less of a scam now?

tubalcain 2y ago

Credentials and skill levels differ widely worldwide. Many developing countries lack the infrastructure to train doctors for modern medicine, and the degree of corruption in those countries increases the risk of unqualified or questionable practitioners. This is not the right way to improve access.